血压、脉压水平及高血压病程对高血压患者动脉僵硬度的影响

目的探讨血压、脉压水平及高血压病程对高血压患者动脉僵硬度的影响。方法从上海市宝山区6家社区卫生中心及本院入选1026例高血压患者,收集相关病史信息,检测其颈-股动脉(C-F)、颈-桡动脉(C-R)、颈-足背动脉(C-D)脉搏波传导速度(PWV),672例患者在随访1年后复测PWV。从血压、脉压、高血压病程3者的不同水平进行分组比较及随访前后对照分析。结果 (1)1、2、3级高血压患者的C-FPWV随血压水平的增高而增快,分别为(12.61±2.76)m/s,(14.35±3.41)m/s,(15.50±2.93)m/s(均为P<0.01)。1级高血压组较2级、3级高血压组C-FPWV差异有统计学意义(均为P<0.01)。(2)随访前后C-FPWV在1级和2级高血压组分别为(12.73±2.91)m/s和(13.39±3.25)m/s,(13.96±3.07)m/s和(14.75±4.10)m/s,差异有统计学意义,而在3级高血压组差异无统计学意义。(3)脉压<40 mm Hg,40～60 mm Hg,≥60 mm Hg 3组C-FPWV随脉压的增大而增快,分别为(11.95±2.60)m/s,(12.94±2.85)m/s,(14.89±3.22)m/s(均为P<0.01)。随访1年后3组的C-FPWV分别较前增快0.70 m/s,0.65 m/s,0.85 m/s,差异均有统计学意义。(4)高血压病程<5年、5～10年、≥10年3组C-FPWV分别为(12.77±2.75)m/s,(12.85±3.07)m/s,(13.76±3.05)m/s,3组比较差异有统计学意义(均为P<0.01),病程越长,C-FPWV越快。结论(1)C-FPWV较C-RPWV、C-DPWV更能反映动脉僵硬度的变化。(2)C-FPWV随血压、脉压水平的增高及高血压病程的延长而增快,3者均为动脉僵硬度的重要影响因素。

Influences of blood pressure,pulse pressure and hypertension duration on the arterial stiffness in patients with hypertension

Objective To investigate the influences of blood pressure,pulse pressure and hypertension duration on the arterial stiffness in patients with hypertension. Methods A total of 1026 patients with hypertension from 6 community health centers of Baoshan District and from our hospital were enrolled in this study.Related medical histories and carotid-femoral(C-F),carotid-radial(C-R),and carotid-dorsalis pedis(C-D) pulse wave velocity(PWV) were recorded and PWV were re-tested in 672 patients after 1 year of follow-up.Blood pressure,pulse pressure and hypertension duration were recorded at baseline and after follow up. Results (1)C-F PWV of the patient with hypertension grade Ⅰ,Ⅱ,and Ⅲ were(12.61±2.76) m/s,(14.35±3.41) m/s and(15.50±2.93) m/s,respectively,all P<0.01.(2)Compared with baseline,C-F PWV was significantly increased at 1 year of follow-up in patients with hypertension Grade Ⅰ (13.39±3.25)m/s vs.(12.73±2.91)m/s,P<0.05] and Ⅱ (14.75±4.10) m/s vs.(13.96±3.07) m/s,P<0.05].(3)The C-F PWV was increased with the elevation of pulse pressure(PP) (11.95±2.60) m/s for PP<40 mmHg,(12.94±2.85) m/s for PP 40-60 mmHg and(14.89±3.22) m/s for PP≥60 mmHg,all P<0.01].After 1 year of follow-up,C-F PWV of three PP groups was significantly increased by 0.70 m/s,0.65 m/s and 0.85 m/s,respectively(P<0.01),compared to baseline.(4)There were significant statistical differences of C-F PWV among the groups of hypertension duration <5 years(12.77±2.75 m/s),5-10 years(12.85±3.07 m/s) and ≥10years(13.76±3.05 m/s),all P<0.01. Conclusions (1) Compared with C-R PWV and C-D PWV,C-F PWV can sensitively reflect the change of arterial stiffness.(2)The C-F PWV is increased with the elevation of blood pressure and pulse pressure,and with the increase of hypertension duration.